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SUPER 1 PHARMACY #618
CH0627930 EAST TEXAS BORDER HEALTH CLINIC
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Covered Entity Details
Entity Name
EAST TEXAS BORDER HEALTH CLINIC
Subdivision Name
East Texas Border Health Clinic DBA Genesis Primecare Marshall 2
Type
HRSA-Funded Health Center
340B ID
CH0627930
Entity Address
400 S Alamo Blvd
Marshall, TX 75670-4260
Grant Number
H80CS08781
Participating Start Date
10/1/2007
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SUPER 1 PHARMACY #618
Pharmacy Address
2610 RICHMOND RD
TEXARKANA, TX 75503
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Ownership change
Contacts
Covered Entity Signing Official
Carla Roadcap, CEO
(903) 927-3782
Contract Pharmacy Representative
Brookshires
W Mark Sullivan, Pharmacy Operations
(903) 877-6852
Signed By Date
4/10/2019
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